Manual handling training does not guarantee safe lifting or less pain

Dr. Leonard O’Sullivan (PhD, MTech, BTech) is a Senior Lecturer in Ergonomics and Human Factors in the Department of Design and Manufacturing Technology at the University of Limerick, Ireland. He is a Fellow of the Irish Ergonomics Society, and a full member of the Institute of Ergonomics and Human Factors (UK), the Human Factors and Ergonomics Society (USA) and the Institute of Occupational Safety and Health (UK). He is a member of the Council of the International Ergonomics Association. He has published over 40 peer-­reviewed journal articles and delivered over 80 international conference papers primarily on work-­related musculoskeletal disorders. He has participated in several EC projects on work related musculoskeletal disorders.

PS: despite sharing a surname, and publishing several papers, with the other O’Sullivan’s from Pain-Ed, they are not related !



While musculoskeletal disorders are no longer thought to be caused simply by mechanical factors, such as lifting and bending, these activities are commonly provocative for people with musculoskeletal disorders such as low back pain. In industry, training in correct lifting technique remains a central focus in the prevention of musculoskeletal disorders  to reduce absenteeism and  associated costs. Occupational ill health is estimated to cost between 2 and 4% of GNP per annum in developed countries, and musculoskeletal disorders are often the most common reason for absenteeism. I was involved in a study of manual handling training effectiveness led by Dervla Hogan (PhD researcher, UCC) and Dr Birgit Greiner (Senior Lecturer, UCC). We recently conducted a systematic review to investigate the effectiveness of manual handling training on achieving training transfer, leading to a positive change in employee’s manual handling behaviour and a reduction of work-related musculoskeletal disorders (WRMSDs) following training. After searching six electronic databases, 13 articles (mostly RCTs) were included in the review. While this review indicates that employees report enhanced understanding and awareness of the principles of manual handling following training, this does not always lead to the expected behavioural change. Overall, the evidence suggests manual handling training is often ineffective at causing a change in employee’s manual handling behaviour and subsequently reducing musculoskeletal disorders. The findings of this could be interpreted in several different ways; manual handling training could (1) be very useful, but has not yet been integrated into practice sufficiently; (2) be better matched to the specific individual, and their unique task demands, at which point it might then be more effective; (3) continue to be ineffective unless it evolves to view pain from a truly biopsychosocial perspective, where pain is clearly differentiated from concepts of local tissue damage, with greater consideration given to a person’s overall health and overall work environment (e.g. job satisfaction) (4) actually increase the risk of pain in some people if it reinforces beliefs that the body is vulnerable and requires considerable protection to prevent it becoming painful.

Preventing and treating musculoskeletal disorders remains difficult. Many biomechanical and psychosocial risk factors are similar for work and non-work related musculoskeletal disorders and this adds to the difficulty of determining whether an injury is work-related or not and also in prescribing treatment. This is not a new problem and one that will not be answered simply by further research.

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